Radiation and Cancer
A Need
for
Action
Radiation and cancer:
A need for action
All of us are exposed to a spectrum of radiation from
both natural and human-made sources. Radiation can
have beneficial uses but exposures also carry health
risks, depending on the level and duration of exposure, among other factors. Medical uses of radiation
to diagnose and treat disease have important benefits for patients but also involve health risks, including cancer. Nuclear power may be useful for producing electricity; yet increased risk of cancer has been
documented along the entire spectrum of the nuclear
fuel cycle. Moreover, nuclear weapons use remains
an inherent risk of nuclear energy production and
may not be reflected adequately in the assessment
of costs and benefits. Wireless technologies such as
cellular/cordless phones, cell phone towers, and wi‑fi
transmitters that emit non-ionizing radiation have
added greater convenience to our lives, but these devices may also pose health risks, including cancer.
To reduce cancer risk, public policy measures are
needed to mitigate unnecessary and involuntary exposures to sources of radiation now affecting millions of people around the world.
can damage DNA, either through direct interaction
between radiation and DNA or via damage produced
by free radicals. Changes in the DNA could lead to
cell death or, if the altered DNA is not repaired, to
cancer or other health effects. Important sources of
ionizing radiation include medical diagnostic x-rays,
computed tomography (CT) scans, fluoroscopy, other
medical and dental radiological procedures, emissions
from nuclear power plants, radioactive fall-out from
use or testing of nuclear weapons as well as naturally
occurring radioactive compounds such as radon.
Non-ionizing radiation (also referred to as electromagnetic fields or EMF) is a type of low-frequency
radiation without enough energy to knock electrons
from their orbits around atoms and ionize them. The
two principal types of EMF discussed in this paper
are extremely low-frequency electromagnetic fields
(ELF-EMF), which are produced when electrical power
is transmitted and distributed, and radiofrequency/
microwave radiation (RF), which is produced by cellular phones, cordless phones, other wireless devices,
and the towers and antennas that support them.
Sources of ELF-EMF include high voltage power
transmission lines (usually on metal towers) carrying
Radiation: What is it?
To reduce cancer risk, public
The electromagnetic spectrum of radiation includes
both ionizing and non-ionizing radiation. Ionizing radiation is any form of radiation with enough energy
to detach electrons from atoms or molecules (to ionize them). This type of radiation includes alpha particles, beta particles, neutrons, gamma rays, and cosmic rays, which differ in energy levels and the extent
to which they can penetrate cells. Ionizing radiation
policy measures are needed
ENERGY (lower ➟ higher)
1 Hz
Low frequency Radio
102 cm
108 Hz
Microwaves
1 cm
to mitigate unnecessary and
involuntary exposures to sources
of radiation now affecting millions
of people around the world.
The Electromagnetic Spectrum
1012 Hz
Infrared
10–2 cm
1015 Hz
Visible
10–5 cm
1016 Hz
UV
10–6 cm
1018 Hz
X-Ray
10–8 cm
1020 Hz
Gamma
10–10 cm
Cosmic
10–12 cm
Wavelength (higher ➟ lower)
NON-IONIZING RADIATION
IONIZING RADIATION
electricity from power generating plants to communities, and power distribution lines (usually on wooden
poles), that bring electricity into houses, schools
and workplaces. Electric lighting generates ELF-EMF.
Fluorescent lighting and other low-voltage lighting
produce higher levels than incandescent lighting.
Other sources of ELF-EMF include electrical wiring
in buildings, electrical appliances, such as radios,
televisions, hair dryers, food processors, microwave
ovens, electric blankets, etc.
Radiation and cancer:
What do we know?
Ionizing radiation
Ionizing radiation causes cancer. It is the beststudied and longest-known cause of human cancer.
Hundreds of studies and comprehensive reviews by
national and international bodies have found convincing evidence that most sites in the human body
are susceptible to the carcinogenic effect of ionizing radiation and some including the thyroid, bone
marrow (white blood cells), breast and lung are particularly sensitive.1–6 Odorless, tasteless, and largely
invisible, ionizing radiation is a stealth carcinogen,
disrupting our DNA and increasing our risk of cancer.
Moreover, radiation damage to our DNA is cumulative
over a lifetime.7
Four primary bodies of evidence support ionizing radiation as a human carcinogen: (1) studies of
atomic bomb survivors; (2) studies of individuals
medically irradiated for diagnostic or therapeutic purposes; (3) occupational studies of workers exposed
to radiation in healthcare, manufacturing, mining
or among the various sectors of the nuclear weapons/nuclear power industries; and (4) environmental
epidemiological studies of communities exposed to
indoor radon and to radiation across the nuclear fuel
cycle.8 For example:
■■ Numerous studies of atomic bomb survivors provide substantial evidence that radiation dramatically increases the risk of leukemia.1
■■ Evidence from studies of atomic bomb survivors,1,8
female radiologic technologists,9 as well as those
examining the use of X-rays among tuberculosis
and scoliosis patients10,11 have documented significant increases in breast cancer risk.
■■ Studies of childhood cancer show that nuclear
fallout in some communities from weapons testing is associated with acute leukemias,12 contamination from Chernobyl nuclear reactor accident
is associated with thyroid cancers,13 and according to one meta-analysis, living near nuclear facilities is associated with a 7–21% increase in
the risk of leukemia.14
■■ Studies of uranium miners show significant elevations of lung cancer from exposure to radon.15,16
Although findings are specific to the type of radiation exposure (e.g. X-rays, alpha particles, etc), the
evidence is overwhelmingly clear: there is no “safe”
level of ionizing radiation, including exposure to low
doses.4,17 The question of risk of cancer at low doses
has been a widely debated issue. One theory suggests that exposure to low doses of ionizing radiation imparts a beneficial, “hormetic” effect. However,
the National Research Council’s 2005 review of available low-dose risk estimates concluded that there
is no beneficial exposure to ionizing radiation—a
small risk of cancer exists even at low doses and risk
increases proportionally with each increase in dose.4
A highly significant remaining question requiring further study is whether continuous exposure to low
doses of ionizing
radiation produces
a different type of
cancer risk. Some evidence suggests that chronic
low-level exposure to ionizing radiation may carry a
higher risk than previously suggested.18,19
Some argue that there are still scientific uncertainties in the low dose cancer risk estimates given
the difficulty in measuring such risks. While the debate continues, one key issue is whether current policies do enough to protect the public from potential
effects of low dose ionizing radiation exposures in the
face of scientific uncertainty. Extensive scientific evidence demonstrates that the risks of radiation are real.
Many scientists believe that ignoring the evidence on
low dose exposures undermines our national efforts
to prevent cancer. Given that cancer risk increases
with each
dose of
radiation,
the prudent course forward is to minimize radiation
exposure wherever and whenever possible.
Non-ionizing radiation
A growing body of evidence suggests that chronic,
low-level exposure to non-ionizing radiation from
radiofrequency/microwave (RF) and extremely low
frequency electromagnetic fields (ELF-EMF) sources
may increase the risk of cancer in children and
adults.20 In 1997, distinguished epidemiologist John
Goldsmith wrote, “The notion that non-ionizing radiation, and in particular RF radiation, was harmless—the assumption of innocence—is no longer
tenable.”21 Hundreds of studies since that time have
confirmed his assertion.
Substantial evidence suggests that ELF-EMF and
RF can damage DNA, modify gene expression, and
Strength of the evidence linking specific cancers with human
exposure to ionizing radiation6
Evidence
A-bomb survivors S t r o n g : bladder, breast (female), colon, esophageal,
leukemia, lung, ovary, salivary gland, skin, stomach, thyroid S u s p e c t e d :
liver, myeloma
Medical irradiation procedure patients S t r o n g : bladder, bone, brain
(CNS), breast (female), esophageal, leukemia, liver, lung, rectum, salivary
gland, skin, stomach, thyroid, uterine S u s p e c t e d : kidney, lymphoma,
myeloma, pancreatic, prostate
Occupational studies S t r o n g : bone, leukemia, lung, skin S u s p e c t e d : breast (female), myeloma, thyroid
Environmental epidemiological studies S t r o n g : lung, thyroid S u s p e c t e d : leukemia
Strength of the evidence linking specific cancers with human exposure to non-ionizing radiation23,26–28,31,76
Radio frequencies (e.g. cell phones) ELF-EMF S u s p e c t e d : brain (CNS), salivary gland
S u s p e c t e d : leukemia, breast (male and female)
lead to altered cellular function as well as cancer.20
Evidence of increased cancer risk is based on studies
in human populations including: studies of (a) RF
exposure from cellular and cordless phone use and
(b) exposure to ELF-EMF from the transmission and
distribution of electrical power.
Cellular and cordless phone use has been studied by experts in many countries only since about
1995. Prior to that time, cellular phones and their
supporting infrastructure were not in widespread
use. Yet, even in this short time, results from the
largest international cell phone studies conducted
under the World Health Organization (WHO) Interphone Study Group are finding an increased risk of
malignant brain tumors (glioma). These tumors are
found at double the expected rate, at only 10 + years
latency (time between exposure and diagnosis of
cancer) when phones are used predominantly on one
side of the head (laterality).22 Additional evidence
has also emerged:
■■ Studies in Sweden and other countries in which
cellular/cordless phones have been used longer
than in the United States also show a consistent
pattern of elevated risk of acoustic neuroma (a
tumor on a nerve that passes from the inner ear
to the brain related to hearing and balance) and
glioma after 10 or more years of use when used
principally on one side of the head.23–25
■■ Meta-analyses of studies with appropriate latency
(more than 10 years), degree of use and laterality
(phone held on predominantly on one or on both
sides of the head) all show nearly a doubling of
brain tumor risk.23,26
The International Association for Research on
Cancer (IARC) classifies ELF-EMF as a Group 2B carcinogen (Possible Human Carcinogen). The IARC classification is based on more than more than 25 years
of study examining the
association between exposure to ELF-EMF and the
risk of childhood leukemia, including the following
key findings:
■■ Two comprehensive meta-analyses using different
pooling techniques found essentially the same
conclusion: high and prolonged average levels of
ELF-EMF exposure were associated with increased
risk of childhood leukemia.27,28 High levels of ELFEMF as defined by these studies (above 4 milligauss [mG]) are very rare, affecting fewer than
1% of children.
■■ Additional evidence suggests an increased risk of
childhood leukemia following maternal occupational exposure to ELF-EMF during pregnancy.29
■■ Men who work in electrical occupations have an
elevated risk of breast cancer, even though the
disease is rare among men.30–32 Two studies in
Sweden33,34 found that women who had both occupational and residential exposure to high-voltage power lines had a higher risk of breast cancer
than those exposed only at home.
Given IARC’s classification and evidence to date,
stronger federal standards and precautionary measures are warranted to reduce exposure to ELF-EMF.
Continued controversy about the links between
leukemia and ELF-EMF is due in part to incomplete
evidence from animal studies and an incomplete
understanding of how ELF-EMF contributes to cancer. However, a new study from China suggests that
genetic variability in DNA repair mechanisms may
make some children more susceptible to leukemia
when chronically
exposed to ELFEMF during prenatal
development.35
Over the past quarter century
the amount of ionizing radiation
the U.S. population receives
each year from medical imaging
has increased five-fold.36
Exposure to every type
of radiation is increasing
Research shows that exposure to radiation is increasing across the electromagnetic spectrum, from nonionizing radiation to ionizing radiation.
According to the American College of Radiology,
over the past quarter century the amount of ionizing
radiation the U.S. population receives each year from
medical imaging has increased five-fold.36 Evidence
among Medicare populations show that trends for
conventional radiography and fluoroscopy use are going down. However, use of mammography, CT scans
and nuclear imaging is on the rise.37 The most worrisome aspect of these exposures is the widespread use
of CT scans on children, particularly in emergency
departments. Although CT scans provide valuable diagnostic information, they deliver 100 to 1000 times
the radiation dose compared to traditional X-rays—
radiation levels that are similar to the low-dose range
shown to increase cancer among atomic-bomb survivors.38 Exposing children to CT scans raises their risk
of developing cancer later in life because children
are more sensitive than adults to the carcinogenic
and other health effects associated with radiation
exposure,39,40 as well as having a longer latency period in which to develop disease. The U.S. Food and
Drug Administration estimates that one abdominal CT
scan for an adult may be associated with a life-time
risk of cancer of 1 in 2000 patients;41 the equivalent
estimated cancer risk for a 1-year old child is much
higher: 1 in 550.42
Ionizing radiation has long been known to cause
breast cancer. As one scientist wrote, “It is likely
that the breast is the organ most sensitive to radiation carcinogenesis in post-pubertal women.”43
Despite this evidence of
potential harm, mammography remains the
“gold standard” for breast
cancer screening. Official guidelines now recommend
mammography screening for women ages 40–49 and
even for women in their 30s who are at high risk for
breast cancer. Some of these women may also have
increased radiation sensitivity.44,45 Undoubtedly mammography is an important early detection tool that
has contributed to the survival of many women with
breast cancer. Yet there is growing international debate about whether mammography screening in large
populations actually reduces breast cancer mortality
rates or, instead, increases the risk of harm, particularly among premenopausal women.46–49 This debate
underscores the urgent need for a non-radiologic
screening technology that would be effective for
women of all ages.
Public exposure to non-ionizing radiation also
has increased dramatically in the last 20 years, particularly to RF radiation. For the first time in the
history of the world, more than 4 billion people
are holding microwave transmitters (cellular/cordless phones) next to their heads for minutes or even
hours every day.50 Moreover, individuals sit in workplaces, public spaces, homes and schools using wireless laptops, personal data assistants (PDAs), and
pagers. Wireless technologies have intensified the
electromagnetic environment with unprecedented
levels of RF that have risen ten-fold to a hundredfold in many urban areas due to wireless transmission for cellular phones.51–52 In addition, wi‑fi networks blanket entire cities with RF.
Children face higher
risk from exposures
The timing of exposure matters. Prenatal and childhood exposure to ionizing radiation pose a greater
cancer risk than comparable exposure during
adulthood.53–54
Evidence from medical irradiation studies clearly
indicates an increased risk of leukemia among children exposed to ionizing radiation in utero.55 Adolescence is another window of vulnerability for radiation-induced cancer, as evidenced among survivors
of Hodgkin’s lymphoma treated with radiation to the
chest as teenagers. These survivors have a high risk
of breast cancer in their 30s and 40s.56
The current weight of evidence suggests that children also are at greatest risk of harm from EMF exposure. More than a dozen high quality epidemiological
studies have linked childhood leukemia to EMF-ELF
electromagnetic field exposure.20,26–28,35 Early indications suggest that children and adolescents also face
a greater risk of harm than adults from RF exposures from the use of cellular/cordless phones.57,58
Researchers have suggested a biological basis for
these observations: since children’s brains are still
developing, their skulls are smaller and thinner than
adults, thus RF radiation is able to penetrate farther
into the brain, which may increase their risk of brain
cancer in early adulthood.58,59
In June 2008, an international panel of physicians and scientists led by Dr. David Servan-Schreiber
and Dr. Annie Sasco endorsed an Appeal in Relation
to the Use of Mobile Phones. The Appeal included
an analysis of recent studies and ten precautionary
measures.60 This Appeal led
Dr. Ronald Herberman, Director of the University of
Pittsburgh Cancer Research Center (UPCRC), to issue a cautionary statement to the UPCRC community concerning the use of cellular phones, including
limiting children’s use of the devices.61 In September 2008, Dr. Herberman and public health expert Dr.
David Carpenter testified at a Congressional hearing
on behalf of a precautionary approach to cell phone
use by children.62 The governments of Germany,63
France,64 Austria65 and the U.K.,66 the European Environment Agency67 and the Russian National Committee on Non-Ionizing Radiation Protection68 have
also warned the public to reduce wireless exposures
and warned against cell phone use by children.
Don’t we have regulations and
technologies to protect us?
Many existing federal radiation protection standards
are based on average lifetime exposure or on a hypothetical adult Caucasian male, 20–30 years of age,
weighing 154 pounds. As discussed above, children’s
bodies are not the same as those of adult men in
their response to ionizing radiation or EMF. Despite
President Clinton’s Executive Order 13045 on the Protection of Children from Environmental Health Risks
and Safety Risks directing federal agencies to ensure
their policies address the disproportionate vulnerability of children, appropriate changes have not been
made in radiation standards.
Early indications
suggest that children
and adolescents also
face a greater risk
of harm than adults
from use of cellular/
cordless phones.57,58
Energy deposition for a cellular telephone at 835 MHz;
radiated power = 600 mW (right). 59 © 1996 IEEE.
“The current lack of uniform
educational standards
nationwide for operators of
radiologic equipment poses a
hazard to the public.”69
—American Society of
Radiologic Technologists
Besides the lack of appropriate testing and establishment of
standards to ensure the safety of
children, current safety standards within our health
care system fail to ensure that medical exposure to
ionizing radiation is minimized for all patients wherever possible. Currently, seven states have no licensure or regulatory provision for radiologic personnel
and six more regulate only partially.69 Most states
only have recommended quality assurance (QA) standards—if they have standards at all. Moreover, many
medical and dental offices do not perform the tests
required to ensure that the standards are maintained.
According to the American Society of Radiologic
Technologists, “the current lack of uniform educational standards nationwide for operators of radiologic equipment poses a hazard to the public. State
and federal standards will ensure a minimum level
of education, knowledge and skill for the operators
of radiologic equipment.”69 Legislation to establish
federal educational standards for operators of radiologic equipment has been introduced in each session
of Congress for the past decade but has never been
signed into law. The Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) bill (HR583 and S1042) passed
the U.S. House of Representatives in June 2008, but
the Senate has yet to act on the bill. Unfortunately,
this bill excludes x-ray, fluoroscopy, ultrasound and
radiation therapy.
All physicians who perform radiologic procedures,
particularly those with office-based imaging equipment, need to be educated and credentialed to minimize unnecessary radiation exposure to themselves,
to staff and to patients during procedures. For example, radiologists have extensive expertise in radiation safety. However, this is not always true for other
specialists such as surgeons and cardiologists. These
specialists have been allowed to perform radiologic
procedures for more
than a decade. However, the first recommended guidelines for safer use
of fluoroscopy by these practitioners were not published until 2004.70
Minimizing patient exposure to medical radiation
also means that standards of care need to change,
particularly in regard to computed tomography (CT)
scans. CT scans are a primary concern because although they represent about 12% of the diagnostic
radiological procedures in hospitals, they “contribute
an estimated 45% of the effective radiation dose to
the public from all medical x-ray examinations.”71
As detailed earlier, this is particularly worrisome
for children given their increased sensitivity to the
carcinogenic effects of ionizing radiation. Moreover,
given the evidence that CT scan doses can increase
cancer risk,41,42 standards of care need to be in place
to ensure that medical practitioners: (1) consider a
patient’s full medical radiation history before recommending additional radiologic procedures; (2) continuously evaluate whether the benefits of the CT
scan outweigh the assumed radiation risk; (3) consider the availability of safer diagnostic alternatives
such as MRIs and ultrasounds; and (4) discuss these
issues with the patient or their caregiver. The role of
ionizing and non-ionizing radiation in carcinogenesis
also needs to be introduced explicitly into all stages
of medical and nursing education.
Safety standards for non-ionizing radiation are
also inadequate to protect public health. Existing
standards are based on acute exposure and on thermal effects alone. This outdated, erroneous concept
assumes that unless EMF exposure is strong enough
to heat human tissue within 30 minutes, it is safe.
Moreover, there are no federal standards for EMF
exposure based on long-term, chronic exposure or
on non-thermal effects, which are the most common types of exposure and the most likely to cause
human health effects, including cancer. In addition,
existing U.S. standards for EMF-ELF are set at 904
milligauss even though more than two decades of
science show that cancer risk may begin to increase
at only 2 milligauss.28 Standards for personal wireless
devices such as cell phones also are based solely on
absorbed heat, measured by a unit called the Specific
Absorption Rate (SAR). The U.S. standard for cell
phones is 1.6 watts per kilogram [W/kg], which is
not sufficiently protective given evidence that health
effects may occur at lower levels.72
Standards are necessary to mandate control of
cancer-causing exposures. However, we also need to
drive innovation and create technologies that reduce
or eliminate radiation exposures. For example, we
need to support the development of technologies
for energy production that rely on safe, renewable
energy sources rather than technologies that carry
the risks associated with nuclear power. Similarly we
need to develop new technologies to reduce medical
radiological risks. Eliminating radiation risks at their
source through redesigning technologies that are inherently safe is an essential element of any cancer
prevention agenda.
Why aren’t EMF exposures
better regulated?
As John Goldsmith wrote in 1995, “There are strong
political and economic reasons for wanting there
to be no health effect of RF/MW [radiofrequency/
microwave] exposure, just as there are strong public
health reasons for more accurately portraying the
risks. Those of us who intend to speak for public
health must be ready for opposition that is nominally
but not truly scientific.”73
Two powerful factors interfere with governments
taking action to set biologically based exposure
guidelines for non-ionizing radiation that acknowledge the current evidence of risk. First, modern societies depend on use of electricity and radiofrequency
communications. Anything that restricts use has potentially significant economic consequences. Second,
electric utility and communications industries have
enormous political influence, and even provide support for a major fraction of the research on health effects of EMF. This financial support for EMF research
may influence how that research is reported to the
public.74
These factors protect the status quo and lead to
scientific publications with conclusions that do not
always reflect the findings of the research. A Swiss
analysis of cellular phone studies found that the
source of research funding affected the reporting of
results. Those studies funded by industry were least
likely to report a statistically significant result.75 In
other words, when industry science manufactures
“doubt” and “controversy,” prudent public health policy actions are delayed. Some analysts suggest this
process mirrors the distortion of science pioneered
by the tobacco, lead, and asbestos industries.
How Can We Prevent Cancer Linked to Radiation?
A comprehensive U.S. cancer prevention agenda will need to safeguard workers and the public, particularly
children, from avoidable exposures to ionizing and non-ionizing forms of radiation. Here are six ways we can
prevent cancer linked to radiation exposure.
■■SUP P O R T research on cancer risk from continuous low-level ionizing radiation exposures as well as the risk
of low-level non-ionizing radiation, especially at biologically relevant exposure levels. This is particularly
important with respect to cell phone exposures, since cell phones are now used by over 4 billion people
worldwide, including growing numbers of young children. Even if cell phone use results in a relatively modest percentage increase in cancer, the global breadth of exposure could result in an increase of incidence of
some cancers of significant public health concern.
■■ENC OURAGE adoption of technologies and practices that reduce workers’ and the public’s lifetime exposure
to ionizing and non-ionizing radiation across all sectors of our economy, including safer cell phone usage
practices, exposures throughout the nuclear fuel cycle, and exposures in health care. We especially need to
find a more effective method for screening and detection of breast cancer that does not expose women to
ionizing radiation, a method that will replace mammography and be effective for women of all ages.
■■SUP P OR T legislation to establish federal standards for education and credentialing of personnel requesting
and performing medical imaging and radiation therapy, and quality assurance regulations that meet or exceed
standards currently in place for mammography facilities.
■■EDUC A TE the public about the risks as well as the benefits of radiological medical procedures, particularly
CT scans for children, and use safer imaging technologies wherever possible.
■■E DUC A TE the public about the sources of EMF exposures and how to avoid or minimize these
exposures for themselves and their children.
■■S TRENGTHEN federal exposure standards for ionizing and EMF radiation to ensure that children
and the unborn are adequately protected and that standards reflect the state of the science
regarding the complexity of disease causation, and reflect the range of exposure circumstances
where people live, work and play.
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This booklet was written by Nancy Evans (Health Science Consultant), Cindy Sage (BioInitiative Working Group), Molly Jacobs (Lowell Center for Sustainable Production
at the University of Massachusetts Lowell) and Dick Clapp (Boston University School of Public Health & Lowell Center for Sustainable Production). The content of this
booklet is also the result of research, discussions and thoughtful scientific review through the Collaborative on Health and the Environment’s (CHE) Cancer Working
Group. Specific contributors from CHE Cancer Working Group include: Ted Schettler (Science and Environmental Health Network), Michael Lerner, Eleni Sotos and Shelby
Gonzalez (Commonweal), Charlotte Brody (Green for All), Jeanne Rizzo (Breast Cancer Fund), Marion Kavanaugh-Lynch (University of California), and Steve Heilig (San
Francisco Medical Society). Additional review was provided by David Kriebel (Lowell Center for Sustainable Production ) and Rachel Massey (Toxic Use Reduction Institute
at the University of Massachusetts Lowell). The booklet was designed by John Svatek at Half-full Design.
January 2009
Additional copies of this booklet can be downloaded at www.healthandenvironment.org and www.sustainableproduction.org.